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PubMed1980

delta 9-Tetrahydrocannabinol for refractory vomiting induced by cancer chemotherapy.

Fifty-three patients receiving antineoplastic chemotherapy who had experienced severe nausea and vomiting refractory to standard antiemetic agents were treated with delta 9-tetrahydrocannabinol (THC). These patients were given THC 8 to 12 hours before, during, and for 24 hours after chemotherapy. Ten patients (19%) had no further nausea and vomiting; 28 (53%) had at least a 50% reduction of nausea and vomiting compared to previous courses with the same agents. No appreciable reduction of nausea and vomiting was seen in 15 patients (28%). Toxic reactions were generally mild, with only four patients experiencing reactions that necessitated stopping THC therapy. We suggest that, since THC is a useful antimetic agent in patients having refractory chemotherapy-induced vomiting, existing restrictions prohibiting its therapeutic use should promptly be eased.

Adult↗
PubMed1984

Altered gastric emptying and prevention of radiation-induced vomiting in dogs.

The relation between radiation-induced vomiting and gastric emptying is unclear and the treatment of this condition is not established. We explored, therefore, (a) the effect of cobalt 60 irradiation on gastric emptying of solids and liquids and (b) the possibility of preventing radiation-induced vomiting with the dopamine antagonist, domperidone. Twenty dogs were studied on two separate days, blindly and in random order, after i.v. injection of either a placebo or 0.06 mg/kg domperidone. On a third day, they received 8 Gy (800 rads) whole body irradiation with cobalt 60 gamma-rays after either placebo (n = 10) or domperidone (n = 10). Before each study, each dog was fed chicken liver tagged in vivo with 99mTc-sulfur colloid (solid marker), and water containing 111In-diethylenetriamine pentaacetic acid (liquid marker). Dogs were placed in a Pavlov stand for the subsequent 3 h and radionuclide imaging was performed at 10-min intervals. Irradiation produced vomiting in 9 of 10 dogs given placebo but only in 1 of 10 dogs pretreated with domperidone (p less than 0.01). Gastric emptying of liquids and solids was significantly suppressed by irradiation (p less than 0.01) after both placebo and domperidone. These results demonstrate that radiation-induced vomiting is accompanied by suppression of gastric emptying. Furthermore, domperidone prevents vomiting produced by ionizing radiation but does not alter the accompanying delay of gastric emptying.

Animals↗
PubMed1984

Role of the area postrema in vomiting and related functions.

Before 1949, the vomiting center was said to be located in the dorsal vagal nuclei of the medulla, but it was uncertain whether two centers existed separately for the control of direct and reflex actions of emetic agents. Borison and Wang then used a stereotaxic technique with electrical stimulation to localize the vomiting center in the reticular formation at a measurable distance from the dorsal vagal nuclei. They also formulated the concept of a separate emetic chemoreceptor trigger zone (CTZ) so that the vomiting center itself is not sensitive to emetic agents and serves solely to coordinate the reflex process. The CTZ was soon identified with the area postrema (AP), but the question remains unanswered whether the CTZ constitutes part or all of tht circumventricular organ. Furthermore, different chemosensory functions, as for defecation and certain forms of autonomic expression, may be represented regionally within the AP. Species that are unable to vomit, e.g., rodents, show other postrema-mediated effects as radiation-induced gastric stasis and drug-induced conditioned taste aversion. In sheep, digitalis-induced arrest of rumination is prevented by postremectomy. It is suggested that these behavioral end points in nonvomiting species may serve for biological assay of antinauseant drugs. Finally, a tabular summary is given of known causes of vomiting in which the AP has been implicated.

Animals↗
PubMed1980

Nausea and vomiting of pregnancy: role of human chorionic gonadotropin and 17-hydroxyprogesterone.

Although nausea and vomiting associated with early pregnancy are extremely common, the causal factors remain obscure. An endocrine etiology for this problem persists as a popular but unproved theory. The present study exn (hCG) and 17-hydroxyprogesterone (17-OHP) and the presence or severity of nausea and/or vomiting in women in the first 16 weeks of pregnancy. The occurrence and severity of nausea and/or vomiting in women with hydatidiform moles in relation to serum hCG levels were also investigated. Levels of hCG and 17-OHP in pregnant women grouped on the basis of severity of nausea and vomiting are compared to each other and to the levels found in normal pregnancies. No relationship could be established between the levels of hCG and 17-OHP and the incidence and severity of nausea and vomiting in either pregnant patients or in women with molar pregnancies.

Chorionic Gonadotropin↗
PubMed1994

Hypnosis in the prevention of chemotherapy-related nausea and vomiting in children: a prospective study.

To study the effectiveness of hypnosis for decreasing antiemetic medication usage and treatment of chemotherapy-related nausea and vomiting in children with cancer, we conducted a prospective, randomized, and controlled single-blind trial in 20 patients receiving chemotherapy for treatment of cancer. Patients were randomized to either hypnosis or standard treatment. The hypnosis group used hypnosis as primary treatment for nausea and vomiting, using antiemetic medication on a supplemental (p.r.n.) basis only, whereas the control group received a standardized antiemetic medication regimen. Nausea, vomiting, and p.r.n. antiemetic medication usage were measured during the first two courses of chemotherapy. Anticipatory nausea and vomiting were assessed at 1 to 2 and 4 to 6 months postdiagnosis. Patients in the hypnosis group used less p.r.n antiemetic medication than control subjects during both the first (p < .04) and second course of chemotherapy (p < .02). The two groups did not differ in severity of nausea and vomiting. The hypnosis group experienced less anticipatory nausea than the control group at 1 to 2 months postdiagnosis (p < .02). Results suggest self-hypnosis is effective for decreasing antiemetic medication usage and for reducing anticipatory nausea during chemotherapy.

Adolescent↗
PubMed1994

[Nausea and vomiting in cytostatic therapy of melanoma patients with the use of metoclopramide and corticosteroid or ondansetron].

Nausea and vomiting develop during surgery, radio- and/or chemotherapy of malignant diseases. Several drugs belonging to different groups of compounds have been used against them in a large scale. After listing these drugs the authors explained their results. Between January 1992 and 1993, 40 chemotherapy-native melanoma patients were treated by emetogen chemotherapy. The incidence, the time-relationship and the number of nausea and vomiting were investigated during the first chemotherapy course. In the second part of the study ondansetron was applied to 50 patients having developed nausea and vomiting in earlier chemotherapy. When using metoclopramide and corticosteroid during the chemotherapy nausea and vomiting developed in 9 (22.5%) and 20 (50%) cases. Nausea 8/50 (11.25%) was observed with the application of Zofran p. o. while vomiting did not develop. Delayed emesis has not been seen during the antiemetic therapies. The laboratory parameters were within the normal range.

Adrenal Cortex Hormones↗
PubMedDate not supplied

Retrospective analysis of postoperative nausea and vomiting to determine antiemetic activity of droperidol added to propofol: a possible drug interaction.

Propofol decreases the frequency of postoperative nausea and vomiting. We investigated whether its antiemetic activity could be improved further by coadministration of droperidol. We retrospectively reviewed the records of 266 women who underwent laparoscopic operations with nitrous oxide anesthesia and thiopental or propofol induction. The records were screened for frequency and time of occurrence of nausea and vomiting, concurrent drug use, duration of surgery, and times of recovery room admission and discharge. The combination of droperidol and thiopental decreased the frequency of nausea and vomiting over droperidol plus propofol, propofol alone, and thiopental alone. The addition of droperidol to propofol anesthesia doubled the frequency of multiple nausea and vomiting episodes, suggesting a possible interaction between the drugs. We cannot recommend that droperidol be added to propofol anesthesia for prophylaxis of postoperative nausea and vomiting.

Antiemetics↗
PubMedDate not supplied

Vomiting as a manifestation of borderline personality disorder in primary care.

BACKGROUND: Patients with borderline personality disorder often are found and treated in psychiatric settings following episodes of self-mutilation, such as wrist-slashing. Family physicians care for many patients with borderline personality disorder, but in primary care settings wrist-slashing or other physical mutilation is a less common presenting problem. Frequently these patients complain of such symptoms as nausea and vomiting that do not so obviously suggest psychopathology. METHODS: Three primary care patients with borderline personality disorder in whom episodic vomiting was the chief complaint are presented. Hypotheses from the literature about the neurobiology of vomiting and self-mutilation are discussed. RESULTS: Vomiting is a primary care analogue of self-mutilation in some patients with borderline personality disorder. CONCLUSIONS: Family physicians should include careful history taking to corroborate other features of borderline personality disorder in evaluating patients with persistent, episodic vomiting. Obtaining a history of early sexual abuse or chronic interpersonal problems as an adult should not only mitigate the compulsion for extensive, costly, and invasive gastrointestinal system evaluations in such patients, but also suggest more effective treatment strategies.

Adult↗
PubMed1993

A prospective study of nausea and vomiting during pregnancy.

The symptoms of nausea and vomiting in pregnancy were described by 363 pregnant women who kept daily symptom diaries. All delivered a single live baby. The majority of information collected was prospective, with the median day from last menstrual period to initial interview by the study midwife being day 57. It was found that 80% of women had symptoms, 28% experienced nausea only, while 52% had nausea and vomiting. The mean number of days from last menstrual period to onset and cessation of symptoms was 39 and 84, respectively, and 40% of women's symptoms ended abruptly. Cessation of symptoms occurred at approximately the same day from the last menstrual period whether they had begun early or later, severely or mildly [corrected]. The median total number of hours of nausea per pregnancy in those 292 women experiencing symptoms was 56, with peak symptoms occurring in the ninth week. Eighty five per cent of women experienced days with two episodes of nausea. Fifty three per cent of episodes of vomiting occurred between 06.00 hours and 12.00 hours. The symptom complex can be defined as episodic daytime pregnancy sickness. Among the study population, 206 women were in paid employment. Seventy three of these women (35%) spent a mean of 62 hours away from their paid work because of symptoms of nausea and vomiting, showing the socioeconomic significance of this condition. The detailed information gathered should help in the investigation of the aetiology of nausea and vomiting during pregnancy.

Adolescent↗
PubMed1993

[Acupressure in the prevention of postoperative nausea and vomiting].

Despite modern anaesthetic procedures, postoperative nausea and vomiting are still the side-effects most often mentioned: acupressure is reported to be an additional method of preventing these effects in minor gynaecological surgery. We investigated the effectiveness of acupressure in patients undergoing gynaecological operations of longer duration (6-8 h) in a verum acupressure group compared to a placebo group. Before beginning the study we investigated a control group to find out the frequency of emesis. In the worst case of nausea that we encountered, 80% in the 0-6 h postoperative period, the number of random samples for the acupressure and placebo groups was calculated (30 patients in each group). The error for alpha was established at 5% and the reduction of nausea was 50%. METHODS. The female patients were 18 to 65 years old (ASA group I and II). Acupressure was carried out by fastening small metal bullets at the point P 6 to each forearm by means of an elastic bandage. The bullets were left there for 24 h. The premedication anaesthesia, postoperative analgesia, and antiemetic treatment were standardized. During a 24-h period we investigated the incidence of nausea and vomiting. RESULTS. The anthropometric data, the duration of surgery and the amount of postoperative analgesia were comparable between the three groups. Verum acupressure obtained a statistically significant and relevant reduction in nausea up to the 6th postoperative hour in comparison with the placebo group (P = 0.03). Nausea was reduced from 53% in the placebo group to 23% in the acupressure group. CONCLUSION. As demonstrated in this group of longer gynaecological surgery patients as well as in chemotherapy-induced nausea and vomiting, we were able to demonstrate that acupressure is an effective method of preventing nausea and vomiting without any side-effects. It is a valuable addition to the prevention of postoperative nausea and vomiting. Further studies should be conducted to investigate this possibility further.

Acupuncture Points↗
PubMed1996

[Ondansetron in the prevention of postoperative nausea and vomiting in ambulatory surgery].

OBJECTIVE: To evaluate the efficacy of antiemetic prophylaxis with ondansetron administered before major ambulatory surgery. PATIENTS AND METHOD: We retrospectively analyzed 1,881 patients (566 women, 31%) who underwent ambulatory surgery for various conditions between January and December 1993; 84% were ASA I, 15% ASA II and 1% ASA III: Mean age was 35.82 +/- 21.66 years; mean weight was 61.26 +/- 21.77 kg, and mean height was 155.13 +/- 19.27 cm. The techniques employed were total intravenous anesthesia in 64.8%, epidural in 22%, regional intravenous in 5.8%, local in 3.8%, peripheral blockade in 2.6% and intradural in 1%. One thousand thirty-three patients were premedicated with 4 mg ondansetron 30 minutes before the start of surgery; the remaining 848 received no antiemetic drug. We determined the incidences of nausea and vomiting during the 24 hours after surgery and the data were subjected to analysis of variance, covariance adjustment for quantitative variables, chi 2 test with continuity correction for nausea and vomiting. RESULTS: The incidences of nausea and vomiting were significantly lower in the patients premedicated with ondansetron. Only 36 (3.48%) of the premedicated patients experienced nausea, in comparison with 63 (7.4%) patients with no antiemetic premedication. Vomiting was experienced by 68 (6.58%) patients who received ondansetron, as compared to 112 (13.2%) patients who did not receive the drug. CONCLUSION: In our experience, administering 4 mg of ondansetron before major ambulatory surgery significantly reduces the incidence of nausea and vomiting in the immediate postoperative period.

Adolescent↗
PubMed1996

[Treatment of postoperative nausea and vomiting with ondansetron in patients administered anti-neoplastic agents].

The antiemetic effect of ondansetron (a 5-HT3 antagonist) was evaluated in patients treated with intraperitoneally administered anti-neoplastic agents (cisplatin and mitomycin-C) during surgery for ovarian cancer. Anesthesia was induced with intravenous thiopental 5 mg x kg-1 and maintained with nitrous oxide 66% in oxygen and isoflurane. After surgery, 6 patients received a single intravenous dose of ondansetron 4 mg (group O), 6 others did not receive ondansetron (group C). Both groups received an intravenous dose of methyl-prednisolone 500 mg. An intravenous dose of metoclopramide 10 mg was provided in case of continued vomiting or at the patient's request as a rescue antiemetic. The incidence of vomiting was 13% in group O and 87% in group C (P < 0.05). Nausea scores (range 1-4) were significantly lower in group O as compared with group C at 4 h and 8 h after surgery. Total dose of metoclopramide was 20 +/- 13 mg (mean +/- SD) in group C and 2 +/- 4 mg in group O. Administration of anti-neoplastic agents during surgery caused severe nausea and vomiting after surgery and ondansetron prevented the occurrence of nausea and vomiting almost completely. We conclude that ondansetron is an effective antiemetic for preventing postoperative nausea and vomiting in patients administered anti-neoplastic agents.

Adult↗
PubMed1996

[Prevention of postoperative nausea and vomiting with single and repeat administration of ondansetron--review of the literature on different administration forms].

Postoperative nausea and vomiting (PONV) is still a common perioperative complication and ondansetron has proved to be an effective antiemetic substance in its prevention. The antiemetic effect of single and repetitive application was evaluated in this study. Fifty-one female patients who underwent gynaecological surgical procedures took part in a random double-blind study. Before the start of anaesthesia, 21 patients (group 1) received either a placebo (six patients), 8 mg ondansetron orally (seven patients) or 16 mg orally (eight patients). The remaining 30 patients (group 2), split into subgroups of ten, were given the same preoperative medication as group 1 plus further doses of the same strength 8 and 16 hours after the first intake of the study medication. Metoclopramide was given intravenously if patients had more than one emetic episode or if they asked for it. Nausea and vomiting were documented up to 24 hours after finishing anaesthesia. Metoclopramide had only to be given to patients who had received a placebo. Nausea was felt by 57% (4/7) of the patients after a single dose of 8 mg ondansetron and by 40% (4/10) of the patients after three doses of 8 mg. One patient (14%, 1/7) with a single dose and two patients (20%, 2/10) with a repetitive dose of 8 mg ondansetron vomited. Following a single dose of 16 mg ondansetron, no patient (0/8) had to vomit and 25% (2/8) of the patients had nausea. There were no complications reported by the patients. Ondansetron was shown to be a well-tolerated antiemetic and seems to have a higher reductive effect on PONV when given in a single dose and not repetitively. The prophylaxis of vomiting seems to be more effective than the reduction of nausea. Follow-up studies will have to clarify our findings.

Adult↗
PubMed1997

The safety and efficacy of granisetron in postoperative vomiting in pediatric patients undergoing tonsillectomy.

A high incidence of vomiting after tonsillectomy is consistently reported in the literature. Multiple trials with different pharmacological agents and alternative anesthetic techniques have been used in an attempt to decrease this, but results have been inconclusive and adverse effects occur frequently. The purpose of this study was to examine the safety and efficacy of granisetron (Kytril) in the prevention of postoperative vomiting in children undergoing tonsillectomy. Fifty-four patients were included in this study. The study population was divided into an experimental (n = 28) and control group (n = 26) using a randomized double-blinded technique. The experimental group was treated with granisetron 10 micrograms/kg intravenously (IV) and the control group received saline solution IV. Episodes of vomiting were recorded throughout the hospital stay and for the 24 hours after surgery. A reduction in the incidence and severity of vomiting was shown to be significant in the experimental group, both in the hospital and at 24 hours postoperatively. High patient satisfaction was also reported in this group. Clinically, the prophylactic administration of granisetron intraoperatively in pediatric tonsillectomy patients should be considered to reduce the incidence and severity of postoperative vomiting.

Age Factors↗
PubMed1997

Risk factors and antiemetic management of chemotherapy-induced nausea and vomiting.

PURPOSE/OBJECTIVES: To review the emetic potential of chemotherapeutic agents and the specific factors that may help to identify patients who are most vulnerable to nausea and vomiting following chemotherapy. To review the classes of antiemetic drugs that effectively control nausea and vomiting associated with chemotherapeutic regimens. DATA SOURCES: Journal articles, abstracts, and clinical experience. DATA SYNTHESIS: The trend toward outpatient care requires aggressive antiemetic therapy from the outset, with clear recognition of the risk factors for chemotherapy-induced nausea and vomiting. The basic categories of antiemetics include 5-hydroxytryptamine, (5-HT3)-receptor antagonists, phenothiazines, butyrophenones, substituted benzamides, and cannabinoids. Additional agents often used in combination with these antiemetics include corticosteroids and benzodiazepines. CONCLUSIONS: The 5-HT3-receptor antagonists offer enhanced control of emesis while causing few side effects. For highly emetogenic chemotherapy regimens, the combination of 5-HT3-receptor antagonists and dexamethasone appears superior to other single agents or combinations in preventing nausea and vomiting. IMPLICATIONS FOR NURSING PRACTICE: Nursing care involves educating patients about self-care initiatives for effective management of chemotherapeutic side effects, including compliance with prescribed antiemetic regimens to prevent nausea and vomiting.

Adult↗
PubMed1997

Postoperative nausea and vomiting. A retrospective analysis in patients undergoing elective craniotomy.

Nausea and vomiting are important complications after craniotomy, for which there are little published epidemiologic data. We retrospectively examined the incidence of postcraniotomy nausea and vomiting to define risk factors. Medical records from 199 adults undergoing elective craniotomy were identified. Data extracted from surgery and the initial 48 hours postoperatively included gender, age, supratentorial versus infratentorial craniotomy, type of anesthesia (general versus monitored anesthesia care), intraoperative fentanyl dose, duration of anesthesia, antiemetic administration intraoperatively and postoperatively, and incidence of postoperative nausea, emesis, and opioid use. Postoperative nausea was recorded in 99 patients (50%) and emesis in 78 patients (39%). Postoperative opioids were administered to 170 patients (85%). Antiemetics were given intraoperatively to 13 patients (7%) and postoperatively to 121 patients (61%). More women (61%) than men (37%) had nausea (P = 0.001); emesis (women = 46%; men = 31%, P = 0.03); and postoperative antiemetic use (women = 69%; men = 51%, P = 0.013). The incidence of postoperative nausea (P = 0.04) and vomiting (P = 0.06) was greater in patients having infratentorial surgery. Emesis was more frequent in younger patients (P = 0.03). Postoperative nausea and vomiting were independent of anesthetic duration, fentanyl dose, or postoperative opioid use and occurred with similar frequency after general anesthesia or monitored anesthesia care. We conclude that postoperative nausea and vomiting occur frequently after craniotomy. Infratentorial surgery, female gender, and younger age are significant risk factors for this complication.

Adolescent↗
PubMed1998

[Effect of diazepam on delayed nausea and vomiting caused by anticancer agents].

We conducted an evaluation of the usefulness of antiemetics (5-Hydroxy-tryptamine 3 receptor antagonism, 5HT3RA) combined with diazepam for delayed nausea and vomiting due to anticancer agents in 17 patients with various malignancies (such as lung Ca, breast Ca, esophagus Ca, gastric Ca, colon Ca, and non Hodgkin's disease) for whom chemotherapy was performed with different regimens in the Dept. of Oncologic Chemotherapy, People's Hospital, Beijing Medical University. Antiemetics (5HT3RA) combined with diazepam were given only to cases that had symptoms of nausea and vomiting induced by anticancer agents in the 1st course and invalidity with antiemetics (5HT3RA) alone in this study. Antiemetic (5HT3RA) agents + Dexamethasone were dosed before chemotherapy and also diazepam 5 mg orally after 24 hours (namely, when nausea was observed). Nausea was reduced and vomiting decreased after the antiemetic treatment with 5HT3RA + Dexamethasone and diazepam. These results indicated that 5HT3RA and diazepam combination therapies were more effective than 5HT3 RA + Dexamethasone alone for delayed nausea and vomiting. Further, the antiemetics had characters that a short adminiter time, few times and a take not over dose. The only side effect related to this antiemetic therapy was light somnolence. Antiemetics combined with diazepam might be a useful therapy against delayed nausea and vomiting induced by anticancer agents.

Adult↗
PubMed1998

[Clinical study on the inhibitory effect of a 5-HT3 antagonist, granisetron, for nausea and vomiting induced by chemotherapy (CHOP, VEPA, high-dose ETP) for non-Hodgkin's lymphoma].

The antiemetic effect of granisetron on nausea and vomiting induced by cancer chemotherapy (CHOP, VEPA, VEPA-B, massive dose of ETP) was studied in fifty patients with non-Hodgkin's lymphoma. There was almost no difference in the inhibitory effect by regimen, with the rates of perfect inhibition of nausea and vomiting standing at 55.6% to 60%. Nausea and vomiting was perfectly controlled in 60% of 35 patients receiving CHOP therapy. As a part of this study, a comparison was made of perfect inhibitory effect on nausea and vomiting by potency of chemotherapy under the potency scale of 750 mg/m2 of CPA as 1, revealing no significant difference in the rates of complete inhibition as 71.4% for a drug potency of less than 0.8 vs 52.4% for 0.8 or above (p = 0.26). However, it was clear that the higher the dose of chemotherapy, the lower the rate of complete inhibition. The results confirmed the high efficacy and safety of granisetron in the treatment of nausea and vomiting induced by cancer chemotherapy.

Adult↗